Provider Demographics
NPI:1497742118
Name:D'SOUZA, GEMMA (MD)
Entity type:Individual
Prefix:DR
First Name:GEMMA
Middle Name:
Last Name:D'SOUZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GEMMA
Other - Middle Name:
Other - Last Name:D'SOUZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:725 W GRANADA BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174
Mailing Address - Country:US
Mailing Address - Phone:386-673-2770
Mailing Address - Fax:386-673-2760
Practice Address - Street 1:725 W GRANADA BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-673-2770
Practice Address - Fax:386-673-2760
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056430208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0056430OtherVOLUSIA HEALTH NETWORK
FL50351OtherBCBS
FL251136300Medicaid
FLME0056430OtherUNITED BENEFITS
FLME0056430OtherCMS
FL50351OtherBCBS
FLU0309ZMedicare ID - Type Unspecified